Musings of a Skeptic Oslerphile

Argyll Robertson: Better Be His Pupil, Than Have It!

Argyll Robertson pupils (“AR pupils”) are bilateral small pupils that constrict when the patient focuses on a near object (they “accommodate”), but do not constrict when exposed to bright light (they do not “react” to light). This condition is colloquially referred to as the “Whore’s Eye” because of the association with tertiary syphilis and because of the convenient mnemonic that, like a prostitute, they “accommodate but do not react” also because the pupils are “small and irregular.” They are a highly specific sign of neurosyphilis. In general, pupils that “accommodate but do not react” are said to show light-near dissociation. (Wikipedia)

Now to come to the interesting parts of the Eponym for the condition.

This condition was named after Douglas Moray Argyll Robertson, who published 2 papers to describe this condition in 1869. He was one of the first surgeons to specialize exclusively in Ophthalmology. The son of a surgeon with special interest in Ophthalmology, he completed his medical education at the very young age of 20 years and immediately forayed into the field of Ophthalmology. It was not the norm of the day since most people chose to go into Medicine or Surgery rather than solely in the then rather limited field of Ophthalmology.

Besides this eponymous condition, which had guaranteed him immortality in medical circles, he has had several other important contributions to the discipline. One of the largest came in 1863, he discovered the miotic properties of Physostigmine from the calabar bean. He correctly fore told that this group of chemicals were going to become of paramount importance in the treatment of ocular conditions. His preceptor, von Graefe, used physostigmine to perform iridectomy in a patient in the very same year he discovered it. Oh, and the real cool thing about the whole business was that he had experimented upon himself and had found the miotic properties of the compound. The true spirit of science! (OK, I can already see the IRBs and IECs looking daggers at me!)

Another important contribution of Argyll Robertson was the fact that he also was one of the first physicians to describe the condition of Ocular Loaiasis.

This remarkable physician was also the Royal Ophthalmologist to none other than Queen Victoria herself (1886). He chaired the Ophthalmologic Society of England for 12 straight years from 1883. He was one of the most respected surgeons of his day.

Yet, he was not a prolific publisher. In fact, in today’s publish-or-perish world, there are pre-med students with more publications than him! He was more of a teacher and believed in the power of the demonstrated lecture as a didactic tool over pages of erudite expression. If only there were more teachers like him nowadays!

But, Argyll Robertson was not just some eye doctor who wielded the scalpel with precision and towered over his colleagues and contemporaries in stature. Within the rigid orthodox boundaries of Victorian England, he was quite the party animal. In fact, a biographical note states:

“His handsome features and his tall, athletic frame made him the cynosure of all female eyes in his youth and in his later years, clad in a grey frock-coat and top hat, his dignified manner combined with his genial old-world courtesy made him conspicuous in any assembly and a magnificent ambassador of Scotland, firmly establishing that country in the social world of ophthalmology. He attributed his good health to golf and considered it the finest recreation in the world. Even though it was recreation, however, he brought to it the same skill he had as a surgical operator, winning the gold medal of the Royal and Ancient Club of St. Andrews five times.”

He was a champion archer and was an honorary member of the Royal Company of Archers, who were the body guards of the Queen in Scotland.

He also has an Indian connection, albeit, in a rather dubious manner! Following his retirement from active hospital service in 1897, he had not been keeping in the best of health. He moved to the Island of Jersey in 1904 and in 1908 made a trip to India. While at a place called Gondal, near what is today known as Mumbai, he caught a cold… and died!

An ardent scholar, a multifaceted individual, a charming party-goer, a legend in his own field, Douglas Moray Argyll Robertson is my choice for the Doctor of the Month for July!

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Pranab Chatterjee

Skeptic Oslerphile, Public Health Specialist and Program Manager, Translational Global Health Policy Research Cell, Ministry of Health and Family Welfare, Government of India; Scientist, Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases. Past: Senior Research Associate, Public Health Foundation of India. Interests include: Emerging Infections, Public Health, Antimicrobial Resistance, One Health and Zoonoses, Diarrheal Diseases, Medical Education, Medical History, Open Access, Healthcare Social Media and Health2.0. Opinions are my own!
View all posts by Pranab Chatterjee

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